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Interview with Allscripts President and Xerox Executive VP About $500 Million Hosting Services Contract

Posted on April 29, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many of you probably already saw the announcement of the $500 million contract that was signed between Allscripts Healthcare Solutions and ACS, A Xerox Company, to provide hosted IT service for the Allscripts’ Sunrise Enterprise Suite. Considering the size of the contract, I thought it would be interesting to do an interview to learn more about the Allscripts and ACS (Xerox) relationship.

The following is an email interview with Lee Shapiro, President, Allscripts and Chad Harris, Executive Vice President and Group President, ACS Healthcare Provider and IT Applications Solutions. They duck a few of the questions, but provide some information about their relationship that I think’s useful and interesting.

Lee Shapiro, president, Allscripts

What percentage of Allscripts Sunrise Enterprise Suite customers use the hosted model vs. in-house servers?
There are approximately 50 remote hosted clients.

Why did Allscripts choose to outsource the hosting after having the infastructure in place?
As the payment paradigm in healthcare shifts and our clients’ growing and complex needs around new regulatory requirements continue to evolve, ACS, A Xerox Company will support Allscripts as it scales to deliver service levels required for diverse healthcare settings.

Immediately ACS will begin to focus on standardizing and optimizing our operational processes, help to manage our Service Level Agreements on system availability and enhance our recovery and security capability.

This alliance also helps us deliver faster client case resolution. Longer term, it will enable us to deliver a richer toolset, broader set of monitoring capabilities, access to geographic data centers and new services. Allscripts will still have a remote hosting business and will continue to manage all aspects of the alliance and client relationships. Data is always available whether it is remotely hosted or not.

Do you expect to outsource the hosting of MyWay and other Allscripts hosted EMR products to ACS down the road as well?
Allscripts is always evaluating options to provide the best service support for its growing and diverse customer base.  Right now, our ACS alliance is the best solution to meet current and projected needs.  We will continue to evaluate.

Are you concerned that customers will have issues with having to work with two large companies?  Instead of “one neck to ring” they will have multiple companies that can point the “proverbial finger” at the other.
Allscripts is excited about this partnership and the response has been overwhelmingly positive. We will continue to manage the client relationship at every level, including sales and support and will also provide our healthcare industry domain expertise in partnership with ACS’s world class remote hosting infrastructure.  This is a single solution for our clients.  It is an exciting combination.

What share of the 96 providers using these remote hosting services are hospital versus ambulatory?
Allscripts has not entered to an agreement with ACS on ambulatory.

Chad Harris, executive vice president and group president, ACS Healthcare Provider and IT Applications Solutions

Describe how the transition of hosting will occur for existing customers.
The transition of hosting services will be seamless for Allscripts customers. From a governance perspective, Allscripts will continue to have a direct relationship with hosted clients, handling overall client relationship management activities including fielding service requests and projects, reporting, invoicing, and sales support.

ACS, A Xerox Company, will run and maintain the current systems by assuming responsibility for day-to-day technical delivery and data center operations, and supporting Allscripts in its continued service of new and existing hosted customers.

As part of the arrangement, ACS maintains the existing Allscripts data centers under what is commonly referred to as a facilities management agreement.  ACS will optimize the data center footprint and technical environment overtime under a structured long term plan involving no impact to the clients.  Additional capacity will be provided to support growth and expansion via ACS’ global data center and operations network.

ACS will introduce industry standard best practices, new tools and other forms of automation, as well as additional services including advanced recovery to improve service excellence, performance and reliability of the hosting operation.

Will Xerox be bringing their expertise in printing and scanning to this relationship as well or only their hosting operations?
While Xerox technology is not specifically part of the current hosting engagement, ACS is investing in a Healthcare Innovation Lab for Allscripts to evaluate integration of new technologies, cloud computing solutions and  client-specific deployment and testing initiatives. In addition, ACS and Allscripts will form an Innovation Council to evaluate future technologies and work processes that will help Allscripts support the changing needs of providers.

After the recent Amazon cloud hosting outages, what’s ACS and Allscripts doing to make sure similar outages don’t occur?
The Allscripts application environments are critical patient care systems and as such require an architecture that supports a very high level availability and performance. Under the new hosting partnership, ACS will work with Allscripts to maintain and improve application uptime and operational resiliency through a high availability architecture and advanced recovery capability. High availability is achieved through the deployment of failover technology, or methods, that ensure system availability and transaction protection. The most common configuration utilizes the active/passive clustering approach.

The Sunrise Clinical Manager (SCM) application is cluster aware and is configured in a clustered environment. ACS utilizes the high availability clustering supported by SCM application servers to ensure that all single points of failure are resolved and the application can quickly return to service after a loss of the primary server

Chicago Hospitals Embark On Long HIE Journey

Posted on April 28, 2011 I Written By

I live in Chicago, a highly competitive healthcare market with some world-class medical schools (Northwestern, University of Chicago, Loyola, Rush) and a pretty decent record of EMR adoption. At least four major institutions/health systems run similar Epic EMRs: University of Chicago Medical Center, Northwestern Memorial Hospital, Rush University Medical Center and, in the northern suburbs, NorthShore University HealthSystem (formerly Evanston-Northwestern Healthcare).

Three NorthShore hospitals–Evanston Hospital, Glenbrook Hospital and Highland Park Hospital–were among the first in the country to reach Stage 7 on the HIMSS Analytics EMR Adoption Model.(NorthShore’s Skokie Hospital since has reached Stage 7). Several others, notably Rush, Advocate Lutheran General Hospital in northwest suburban Park Ridge, Mercy Hospital & Medical Center and  Swedish Covenant Hospital, have gotten to Stage 6.

But there’s been very little effort to interconnect these institutions and affiliated physician practices. Even during the RHIO heyday of 2004-07, I don’t recall much interoperability talk in the Chicago area. (In fact, one family physician, Dr. Stasia Kahn, in far west suburban St. Charles, got so frustrated that she formed her own group to promote EMR adoption and health information exchange, Northern Illinois Physicians for Connectivity. I had heard talk for a while of some south suburban hospitals joining in an HIE with counterparts across the state line in Northwest Indiana since Illinois was moving too slowly.)

All of that non-action at the state and regional levels happened under the not-so-watchful eye of one Gov. Rod Blagojevich, who apparently was more preoccupied with his own vanity and “giving healthcare to kids” (while also allegedly trying to blackmail the CEO of Children’s Memorial Hospital into donating to his campaign fund and also slowing Medicaid payments to pay for his All Kids program) than in, you know, actually improving healthcare for everyone by promoting HIE.

In February 2009, shortly after Blagojevich was removed from office and a couple weeks before the federal American Recovery and Reinvestment Act became law, new Gov. Pat Quinn signed a law allocating $3 million to the state’s Department of Healthcare and Family Services for HIE planning. That laid the groundwork for this week’s widely publicized announcement that the not-for-profit Metropolitan Chicago Healthcare Council had chosen technology from Microsoft, Computer Sciences Corp. and HealthUnity to build what could be the largest big-city HIE in the country, potentially serving 9.4 million people in nine Illinois counties and small parts of Indiana and Wisconsin.

I bring all of this up because I met yesterday with executives from the Metropolitan Chicago Healthcare Council, a 76-year-old coalition of healthcare organizations in and around the city. It just so happened that the 2011 Microsoft Connected Health Conference was in town this week, so it was the perfect time and location for Microsoft to drop the news. According to MCHC Vice President Mary Ann Kelly, more than 70 percent of the council’s 150-some members have made a commitment to participate, and they seem to have a plan to make the HIE effort sustainable.

The exchange will operate on a subscription model, with the vendors taking on some of the risk, Kelly said. “The subscription fee will be based on the benefit each member derives,” Kelly explained.

Initially, the exchange will involve 22 hospitals in nine organizations, said Teresa Jacobsen, the council’s HIE director. “We want to get one or two use cases running first,” she said. They will start by linking emergency departments to exchange clinical summaries and for syndromic surveillance, according to Jacobsen. Once that’s going, the HIE plans on adding medication and allergy lists, diagnostic testing results and Continuity of Care Document reports, as well as additional elements for public health, including immunization records.

It all sounds great, and it’s a good idea for them to start slowly, but I wonder when and if smaller physician practices will get involved. My own physician has had an EMR for a while, but not every doctor in the practice uses it. (The four-physician practice recently upgraded to the Meaningful Use Edition of Sage Intergy and has started the 90-day clock for qualifying for Stage 1 Medicare incentives this year, but there’s essentially zero interoperability with other healthcare entities, unless you consider faxing records to others straight from a computer interoperability. I sure don’t.)

My guess is that scenarios like this are playing out all over the country. I wish them luck, but I’m not counting on nationwide interoperability for many years. For one thing, the federally funded, state-chartered Illinois HIE Authority held its very first organizational meeting Wednesday afternoon. “That’s the biggest wild card we don’t know,” MCHC CFO Dan Yunker said.

It’s key to getting payers—particularly Illinois Medicaid—on board with HIE and linking metropolitan exchange networks across the state and beyond. “Our hospitals in Chicago are responsible for the snowbirds who are in Naples (Florida),” Yunker noted. They’re also responsible for patients who come from places like Rockford, Springfield, Champaign, Carbondale and the Quad Cities for certain specialized services only available in the big city.

Yeah, this interoperability thing isn’t so easy.

Meaningful Use Medicaid Overview

Posted on April 27, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A regular reader of EMR and HIPAA, Wes Kemp, sent me an interesting set of slides/PDF file that gives a meaningful use overview from a Medicaid perspective. I always transgress Medicaid when it comes to meaningful use and the EHR incentive money. Plus, I thought he had an interesting way of displaying the meaningful use overview. Since I hate PDF’s, I did it as an embedded document below. For best viewing, click on the Full Screen button, or you can always download it as well.

“Tell Me Something I Don’t Know” with Jonathan Bush from AthenaHealth

Posted on April 26, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I got the request at HIMSS 11 to be able to sit down and talk with Jonathan Bush, CEO of AthenaHealth, I knew that I had to take it. Him and I had a very interesting conversation and he’s a fascinating individual since you never know what he might say next.

On that note, I decided that I better get Jonathan Bush on video at HIMSS. In fact, I think it might have been the only video I did at HIMSS. Although, once I saw how easy it was to upload this video from my phone, I might have to do more EMR related videos on the future. Although, I’ll probably need to hold it the other way.

Now to the video. The basic idea of “Tell Me Something I Don’t Know” comes from the Sunday show that Chris Matthew’s does. In the segment, the people try and tell you something you probably don’t know. I decided to do the same with Jonathan Bush using the various buzzwords at HIMSS: meaningful use, ACOs, incentive money, and healthcare reform.

Video of Jonathan Bush at HIMSS 11
Sorry the video quality and ambient noise isn’t the best. It was on a cell phone in a crowded exhibit hall.

Side Note: If you like videos, let me know. I’m thinking about doing more of them. Possibly some Q and A style videos. If you are interested, drop a question in the comments and I can use them for a future video.

Meaningful Use Measures: CPOE – Meaningful Use Monday

Posted on April 25, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

CPOE (Computerized Provider Order Entry), is the direct entering of orders into a computer (or mobile device), so that the order is documented in a digital, structured, and computable format.

Meaningful Use Core Measure: CPOE
More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.
Exclusion: providers who write fewer than 100 prescriptions during the reporting period.

CPOE is one of the measures that elicited quite an animated response from the provider community. When initially proposed, this measure required 80% of all orders to be directly entered by the provider. To overcome objections to the scope of the requirement and the burden it would impose, CMS ultimately limited the measure to medication orders and reduced the threshold to 30%. (The proposal for Stage 2 reinstitutes lab and radiology orders, but the requirements have not yet been finalized.)

There was also a great deal of conversation about who has to enter the order into the EHR—does it have to be the authorizing physician him/herself? This is the only measure in the Final Rule in which CMS addresses who can perform the function, identifying “…any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.” While some providers are unsure about where these specific guidelines can be found, CMS does provide further guidance, stating that CPOE should be done by someone who can exercise clinical judgment and take action based on the alerts and/or clinical decision support information that the order might generate.

Because for now CPOE is limited to medication orders, it is accomplished either in the course of ePrescribing or by using the same workflow but not transmitting the prescription electronically, (e.g., when prescribing controlled substances or prescribing for patients who request a printed prescription.) All of these prescriptions count in the numerator of this meaningful use measure because they are entered into the EHR.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Weekend Healthcare IT and EMR Twitter Roundup

Posted on April 24, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You know on the weekends I love to through in a little round up of some interesting things said about healthcare IT, EMR and other topics on Twitter. Hopefully, they’ll educate, entertain and inform. If not, tomorrow’s another edition of Meaningful Use Monday.

I’ve been talking about this quite a bit lately on this blog (see my post about social media EMR information). However, I love how the described their shift from newsletters to tweets and blog posts since they’re more current. I obviously agree. Although, if you subscribe to the EMR and HIPAA email you can enjoy the convenience of an email newsletter with the current info of a blog.

I saw this announcement a while ago. I’m really excited to see what Rock Health is able to do. They definitely have a number of big names. I wish that I was some way involved with them since I love their approach. Plus, I’m really excited to have my brother, David, participating with me on the Smart Phone Healthcare website I recently launched. Mobile healthcare is a really hot area of the market and I think together we’re going to bring some interesting perspectives to the mobile area of healthcare.

I usually hate PDF’s and a tweet in a blog post that leads to a PDF is probably even worse. Although, it has an interesting format for considering the multiple e-Prescribing incentive programs. Of course, if you’re a regular reader of the site, then you already have started ePrescribing right?

This just made me laugh and so I had to share it. Although, if you Like EMR and HIPAA on Facebook, then it will be so much better than prison. Well, maybe not much better, but it will make me smile.

I’m a Plumber Despite Just Wanting to be an EMR Blogger

Posted on April 22, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

About a month ago, the market finally fell enough for my wife and I to buy our first house. It’s pretty exciting to finally be able to do it since we pretty much tried to buy a house every year since we moved to Las Vegas 6 years ago. Thankfully, we never did until now (although that’s another story).

After purchasing the home, I found myself spending a fair amount of time having to repair a number of things around the house. One day I pretty much spent all day being a plumber as I (and a nice friend) replaced the garbage disposal, fixed a leaking sink, replaced the mechanism (whatever it’s called) in the toilet. Turns out that none of these things are really all that difficult. Although, it definitely had the initial learning curve for me to realize that it’s pretty straightforward once I got into it.

After spending the day as a plumber on my new house, I couldn’t help but think, “I’m doing the job of a plumber and all I want to really do is blog.”

Many of you are probably wondering what any of this has to do with EMR and healthcare IT. Well, I am the EMR blogger who loves analogies (see marriage and divorce, pregnancy, marriage for money, weight loss, and Katherine posted a Lady or the Tiger one that I enjoyed).

The comparison seems obvious to me. There’s a whole lot of doctors out there that really don’t want to be IT project managers. They don’t want to be EMR implementation specialists. They don’t want to be EMR Contract negotiators. They don’t want to be software evaluation specialists. They want to practice medicine by providing care to patients.

Of course, many of you might easily suggest that I could have paid someone else to do the plumbing and I could stick to the EMR blogging like I want. This is absolutely true. I’m sure there were plenty of plumbers that would have been happy to take my money. Unfortunately, they charge an arm and a leg and I like my limbs. Plus, there’s something valuable about having the knowledge of how something that I’m going to use every day is done.

Extend that to doctors. They could certainly hire an EMR consultant to come and help them do their EMR implementation. In fact, my first job doing EMR was partially to solve this issue. They needed someone who could take care of the EMR implementation from top to bottom. If you find the right person, there’s no doubt that it can work very well. However, similar to the plumber, there’s a cost associated with doing that. Plus, if you use a consultant, you’re outsourcing some of the knowledge and expertise that you would gain if you and your staff put your nose to the grindstone and did it yourself.

Plus, while I can’t say that I particularly enjoy plumbing, I have to admit that there really was an amazing feeling of satisfaction knowing that I was able to accomplish a task which I’d never done before. I think many doctors and clinics have had that same sense of satisfaction after implementing an EMR in their office.

More Unrealistic Expectations From the Public, This Time Involving CDS

Posted on April 21, 2011 I Written By

Yet again, someone needs to educate the general public about healthcare in general and health IT in particular.

HealthLeaders last week asked the question, “Does Decision Support Make Docs Look Dumb?” The story, apparently based on a 2007 study (not 2008, as HealthLeaders reported) in the journal Medical Decision Making, says: “Most clinicians would agree that evidence-based decision support tools have the potential to improve clinical quality. But patients’ perception of the tools—and the physicians who use them—might be yet another barrier to their adoption. The problem is twofold: Some patients are skeptical of docs who need a computer to help them make a diagnosis. And some physicians don’t want to be seen as being too reliant on technology.”

We’ve long known that physicians have resisted clinical decision support, for a variety of reasons. They trust their professional judgment. When they only have a few minutes with each patient, they believe it simply takes too long to look up information that might help reach a more accurate diagnosis or devise a better care plan. The technology simply isn’t up to snuff. Or there isn’t enough electronic data available on each patient for CDS to have a positive effect.

But to read the conclusion of that Medical Decision Making study is to see an entirely different excuse for shunning clinical decision support: “Patients may surmise that a physician who uses a [decision support system] is not as capable as a physician who makes the diagnosis with no assistance from a DSS.”

HealthLeaders interviews other clinicians and researchers who have found similar sentiments. “Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them,” Illinois State University information systems professor James Wolf tells the publication.

“Physicians are reluctant to adopt computer-based diagnostic decision aids, in part due to the fear of losing the respect of patients and colleagues,” Wolf adds.

If this is true, it represents failures on many levels. IT systems designers haven’t made their technology easy to use. Physicians and healthcare entities haven’t done a good job educating patients and journalists like myself have truly failed the public by continuing to feed them false expectations about healthcare.

First off, Wolf’s statement that patients feel like they wasted only a $25 copay perpetuates the myth that a physician office visit only costs $25. If patients think they may have wasted $25, how do you think insurance companies and employers must feel that another $150 of their money went out the window?

The part about losing respect is perhaps more troubling. Physicians need to put their fragile egos away and do whatever they need to do to provide better care. The status quo just isn’t cutting it.

I’ve had the distinct honor of interviewing Dr. Larry Weed on several occasions. Weed, the octogenarian inventor of the problem-oriented medical record and the SOAP note, has been calling for CDS and other IT for more than half a century. Yes, more than half a century. He’s been actively working on such technology since the early 1970s. In a 2009 interview with the Permanente Journal, Weed said:

Computer technology maximized access to voluminous data and knowledge, thereby exposing the limited information processing capacity of the human mind. Scientists cope with this limitation by controlling the research environment, defining the variables involved, and limiting the scope of their investigations. Practicing physicians do not have that luxury. The time constraints of practice and the enormous scope of information implicated by multiple problems in unique patients make it impossible for the human mind to function with scientific rigor. Physicians inevitably resort to dangerous cognitive shortcuts.

I realized that medicine must transition from an era where knowledge and information processing capacity resides inside a physician’s head to a new day where information technology would provide knowledge and the processing capacity to apply it to detailed patient data. The physicians’ unaided minds are incapable of recalling all the necessary knowledge from the literature and processing it with data from the unique patient. An epidemic of errors and waste is occurring as we persist in trying to do the impossible. Changing this requires that we recognize the crucial distinction between electronic access to information and electronic processing of information. This requires a rational standard of data organization in medical records. Yet, these points are still not recognized in most current discussions of health information technology.

As a result, I have been involved for the last 60 years in trying to design and develop a medical care system in which patients are no longer dependent on the limited, personal knowledge their caregivers happen to possess. The medical care system must resemble the transportation system, where consumers use knowledge captured in maps, road signs, computerized navigation devices, and the like at the time of need. Patients, like travelers, will be expected from childhood on to develop the necessary skills to navigate the system.

At all times, patients should be supported by caregivers who are highly trained in the necessary hands-on skills, like removing the appendix or listening to heart sounds, just as in the travel system there are pilots, mechanics, air-traffic controllers, and others who perform functions that travelers cannot perform.

Yet, few outside of academic medicine have ever heard of Weed and his pioneering work. Instead, we rely on shoddy reporting and sound bites designed to score political points to shape our opinions. Why do you think the debate around “healthcare reform” focused so much on insurance coverage rather than actual care? And why do you think patients still believe office visits and prescriptions really cost just $10 or $20 or $30? And why do so many people still expect their physicians to know everything?

We must do better.

Rural vs. City Medical Record Perspective

Posted on April 20, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at the ACP conference in San Diego (yes, it’s fun for a tech person to attend a medical conference), I had a really interesting conversation with a medical records lady from Cardone EHR Solutions. In our discussion she highlighted an interesting difference between the rural and city perspectives on a medical record.

In essence…

Rural clinics want to keep the medical record forever. City clinics want to get rid of as soon as possible.

When she said this idea, it really rang true to me. Of course, the real issue has to do with liability. The real issue is how litigious our society has become and I think it’s fair to say that those in the urban environment are more litigious than those in the rural setting. That’s why clinics in a city generally want to dispose of the record as soon as is legally possible. They don’t want to be held liable for a record that’s 20 years old. However, the rural community would be aghast at the idea that a clinic wouldn’t keep their clinical record forever. Of course, it’s quite likely that many of those in the rural community will be going to that doctor or hospital for their entire life.

I’ll admit that I’m far from an expert on the differences in these environments, but I found this perspective quite interesting. Has some interesting impacts as clinics and EHR vendors start to discuss the idea of records retention in a digital world.

Another side benefit to talking with Cardone EHR Solutions at ACP was that I got a chance to meet Dr. J. I guess it’s fitting to have Dr. J at a conference for doctors.

Interview with Meaningful Use Physician #23

Posted on April 19, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday morning, River Falls Medical Clinic (RFMC) of River Falls, Wisconsin, attested for Meaningful Use at 7:30 a.m. CT. The clinic was one of the very first – in fact, #23 to attest to meaningful use under the Medicare program. The following is an email interview I did with Dr. Tashjian about RFMC’s experience in the meaningful use attestation process.

Christopher H. Tashjian, MD is the president of River Falls, Ellsworth & Spring Valley Medical Clinics in Wisconsin. The three clinics provide primary care services as well as specialty consults.

How long have you been using EMR? Which EMR do you use?
River Falls Medical Clinic, RFMC, implemented Cerner’s Ambulatory EHR in March of 2010 after several years of working with Cerner’s PWPM solution.

Did you have to upgrade your EMR to meet the certified EHR and meaningful use requirements?
From day one of EHR implementation, our staff has made it a priority to utilize our EHR solution to its full extent to benefit the care we deliver to our patients and to enhance our workflow. From the time Meaningful Use was announced, our staff was quick to realize that the proposed criteria would help us to better utilize our EHR and to enhance the care and delivery of that care our patients. We made it a goal to not simply attest for Meaningful Use for the monetary benefits that the stimulus dollars provided, but to more importantly enhance patient care. Therefore, we did not upgrade our EHR to solely meet the certified EHR/Meaningful Use requirements. We did add several pieces into our daily routines including Cerner’s departure summary and patient education –even though this piece isn’t required this year, we know that it will be in stage 2 and beyond. We also continued to improve our eprescribing procedure. We will also be upgrading to include Cerner’s IQHealth® solution to provide a patient portal that enables patients to review their own information and interact with us within a secure platform.

How much did it cost for you to do that?
There is a cost to move to an electronic record from paper – RFMC’s physicians feel it is vital to recruit today’s top medical students/residents. We felt if we did not have an EHR, we were at a serious disadvantage. More than 70% of the physicians in our area have gone electronic– we had to stay up-to-date. Patients in our area want to see a physician who has embraced technology and made the commitment to enhance patient care and safety; they want a physician who is moving forward with technology, not one who is still using paper when a better option is available. There is a cost associated with being a provider of choice and RFMC, like any other physician office, wants to attract new residents (physicians) and new patients. Providing better care is one way to do this. There is no way we could stay competitive in the marketing place if we did not choose to go electronic. The cost of not doing so was too high.

Why was it important to you/your office to be one of the first physicians in the nation to attest?
We wanted to make sure we were doing it right – we looked at the Meaningful Use requirements and said, “These things all appear to provide measurably better care.” Our physician’s felt that meeting Meaningful Use requirements would point our focus in the right direction. Most importantly, we wanted to follow the steps to enhance care. There is value in being one of the first physicians to attest and in being able to tell our community that RFMC is up and running at the first opportunity. This is of significant value to us. Additionally, our physicians literally put their own dollars into the HER; we made a personal investment in this. Many private groups owned by physicians have followed the same suit. This is not a situation where we just said, “Okay, we can rearrange some dollars.” If we don’t succeed – we don’t take our money home. It’s very personal to us as individuals and meaningful because we practice medicine to help our patients. Additionally, we wanted to be able to assist our fellow physicians in the process. By being one of the first physicians in the nation to attest, I can provide feedback and suggestions to assist others in the field.

How many hours of extra effort do you estimate it took for you and your staff to meet the meaningful use criteria?
We were committed to meeting Meaningful Use requirements already, so it’s difficult to say exactly how many hours we put into this initiative specifically. There were many hours spent making sure we met the requirements. We felt the requirements were so valuable and worthwhile that we began working on them day one because we felt they would enable us to deliver better care for our patients. Instituting an EHR required significant effort to change the way we document and the way we take care of our patients, but we saw this as part of the natural cost of doing business and we chose to do it in real time rather than seeing fewer patients. Our staff simply worked more hours – longer hours –so we did not interrupt the care to our patients. Within 6 weeks we were back up and running at full speed – this really is a fairly rapid adoption.

What were some of the changes you had to make to your practice style or documentation methods to meet meaningful use?
We aim to have all notes completed the same day. For us, this was a huge transition from the dictation world. Our team had to learn to document electronically and have things done by the time the patient left the room. This is vital for our patients incase they find themselves visiting the ER that night or seeing another physician that day. In these cases – the information on their visit with our physicians is complete and available. We also completely transitioned from writing prescriptions and went all eprescribe.

There were several changes in the way we practice. For example, now, every visit ends with the patient summary, which I never did before. Now, I sit down with the patient and whoever is with them to discuss, “Here is what we did, here are the tests we conducted today, the labs we completed and prescriptions written.” I provide a full, comprehensive overview of their visit. Incorporating the patient summary into the exam has enhanced my relationship w/my patients and they feel more confident walking out the door. Before, visits ended with a physician writing a prescription and saying goodbye.

We’ve also decided to put printers in every room to provide the after visit summary to our patients. We want everyone to receive their after visit summary and to get the appropriate patient education. We’ve gone to two-sided printing for all documents, so we aren’t printing anymore than what is absolutely essential for each situation. This is helpful for our elderly patients who are on multiple medications, which can get confusing. It’s easier to keep track of everything if it’s written down. We’ve also received feedback that this is valuable for their caregivers who may not have been in the exam room with them. On the other end of the spectrum, this is incredibly beneficial to parents of children, particularly newborns. Parents want to track progress and they want to be able to easily recall information. As we adopt Cerner’s IQHealth®, we anticipate moving the majority of this information into the patient portal for easy accessibility and storage in one central location. We also regularly utilize the immunization registry, which we did not engage with previously.

What steps did you take to ensure you were ready to attest?
To ensure we were ready to attest, we used the reporting capabilities within Cerner’s solution to extract the appropriate data. We used weekly reports to note where each physician was in regards to meeting the requirements for attestation. We also enlisted the support of WHITEC, The Wisconsin Health Information Technology Extension Center, to make sure we covered every base.

Were there any surprises in the meaningful use attestation process?
I was overall impressed that the process was put together so meticulously. There were multiple forms that needed to be filled out as we went through the process, and our staff truly did their due diligence prior to “pushing the button” to ensure we were ready. Thanks to the staff’s preparation, we were prepared when the numbers were requested. It was very easy for us.

Who helped you through the process (your vendor, a consultant, your REC, etc)?
Cerner played a large part in our success. Early on, we began working with Karen Berg, a Cerner Ambulatory director, who came to our clinic to meet with our quality physicians and walk us through the process of getting signed up for Meaningful Use. Berg worked through our questions to help physicians get ready to attest. She highlighted the need for us to prepare for Meaningful Use and beyond and laid out foundational steps for us to focus on patient care beyond Meaningful Use. We have been pleasantly surprised by the wealth of resources available through uCern, a collaborative website for Cerner clients, and we use them regularly. Additionally, our office manager receives regular emails from a group of people at Cerner who are dedicated to help their clients attest and prepare for certification. On our behalf, Cerner also works hand-in-hand with WHITEC, a health information technology extension group that our peer review organization put us in touch with. WHITEC has been very helpful for directing us through the Centers for Medicare and Medicaid Services website and doing research around questions that arise.

What benefits are your patients seeing from you showing meaningful use of an EHR?
Overall, our patients are receiving better quality of care as a result. They’re receiving patient education as well as after visit summaries and their information is tracked for accuracy. Their immunizations, which are one of the most complicated things for parents of minors to track, are recorded in the immunization registry and interfaced with the Wisconsin Immunization Registry. We’ve eliminated errors through eprescribing, there are simply no more errors due to handwriting legibility. They don’t have to worry about losing a prescription, because we send it directly to their pharmacy electronically. Eprescribing also conducts side effect checking and keeps record of the time and date a script is written and sent. Interoperability is a huge benefit for our patients – there is now no need to transfer things to other physicians in our 5 sites, which saves the physician and patient time.

What efforts are you taking to progress towards meeting meaningful use stage 2 and beyond?
RFMC is excited to move forward towards Stage 2 and beyond. We’re already working on next year’s goals; that is, giving diagnosis related patient education to my patients.” We have implemented Patient Education within our practice. We’re moving ahead to continue to deliver the best to our patients.

What do you say to your fellow doctors who are concerned about implementing an EHR in their practice?
I have never met a physician (who has moved to electronic records) say they would like to go back to paper. True, it requires a concerted effort to move to the EHR but the gains in patient care are worth it.

What do you know now about attesting for meaningful use that you wish you knew prior to attesting?
Be organized, choose the right vendor and all will go smoothly. If you actively work to do what is in the best interest of the patient, meaningful use will naturally follow.

What can you share with other physicians who are getting ready to attest in the next weeks and months?
There is very little way to prepare other than to prepare your attitude. Meaningful Use is the way the industry is going and we’re on board with a focus on our abilities to better our care – it’s a job standard to move in this direction. So, jump on board.